La place du médecin généraliste dans la prise en charge du couple infertile

L infertilité toucherait 80 millions de personnes dans le monde. En France, il touche environ 15% de la population. Un couple sur six consultera pour infertilité. Le recul de l âge de la femme à la première grossesse qui est passé de 26 à 30 ans, le mode de vie et les facteurs environnementaux dans notre société actuelle ont un rôle majeur dans la fertilité du couple et dans l évolution et l augmentation de la demande d assistance médicale à la procréation. Le but de notre travail sera de déterminer la place du médecin généraliste dans la prévention, la prise en charge initiale et l accompagnement du couple infertile. Nous avons donc mené une enquête quantitative et descriptive auprès d un échantillon représentatif de 600 médecins généralistes de la région Picardie par le biais d un questionnaire. Nous avons obtenu 115 réponses soit 19,1% de participation. Les résultats au questionnaire montrent que les médecins généralistes prennent en charge les patients qui consultent pour infertilité, ils estiment avoir un rôle dans la prévention, la prise en charge initiale, l accompagnement, le soutien psychologique et l aide à la réflexion. Il serait ainsi intéressant de permettre au médecin généraliste de suivre des séances de Formation Médicale Continue et de leur permettre d accéder à un réseau de soin Médecins Généralistes- Gynécologues- centre d AMP pour une prise en charge optimale. Il serait également intéressant de rendre la consultation préconceptionnelle obligatoire et de sensibiliser d avantage la population en âge de procréer. Le médecin généraliste a donc un rôle dans la prévention, la prise en charge initiale, l accompagnement et le soutien psychologique des patients.Infertility affect 80 million people worldwide. In France, it affects about 15% of the population. One in six couples consult for infertility. The decline of the woman's age at first pregnancy is increased from 26 to 30 years, lifestyle and environmental factors in today's society have a major role in the fertility of the couple and the evolution and increasing demand for medically assisted procreation. The aim of our work is to determine the role of the general practitioner in the prevention, care and support of the initial infertile couple. We therefore conducted a quantitative and descriptive with a representative sample of 600 general practitioners in the Picardie region by means of a questionnaire. We obtained 115 responses or 19.1% participation. The results of the questionnaire show that GPs support patients who seek treatment for infertility, they feel they have a role in prevention, initial management, coaching, counseling and support for reflection. It would be interesting to allow the General practionner to attend sessions of Continuing Medical Education and give them access to a network of General practionner-care-center Gynecologists AMP for optimal management. It would also be interesting to make mandatory preconception consultation and awareness benefit the population of reproductive age. The General Practionner has a role in the prevention, initial management, coaching and counseling of patients.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Colorectal endometriosis-associated infertility: should surgery precede ART?

International audienceTo compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility

Hypertensive pathologies and egg donation pregnancies: Results of a large comparative cohort study

International audienceObjective: To determine whether egg donation (ED) pregnancies are at higher risk of pregnancy-induced hypertension (PIH) than those achieved by autologous assisted reproductive technology (ART; controls). Design: Anonymous comparative observational matched cohort study. Setting: Assisted reproductive technology centers. Patient(s): Two hundred seventeen ED and 363 control singleton pregnancies matched at 7-8 weeks (pregnancy date, parity, cycle type [fresh/frozen] and women's age). According to French practice, all women were under 45. Intervention(s): None. Main Outcome Measure(s): Percentage of PIH for ED versus controls. Result(s): The groups were comparable (mean age, 34.5). PIH was more frequent during ED pregnancies (17.8% vs. 5.3%), as was preeclampsia (11.2% vs. 2.8%) and eclampsia (1.8% vs. 0.0%). In multivariate analyses, PIH risk increased with ED (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.93-7.97) and women's age (OR, 1.08; 95% CI, 1.00-1.16). No significant effect of previous pregnancies or cycle rank/type was observed. Conclusion(s): This study had sufficient power to detect doubling of the PIH rate. It was demonstrated that the risk of PIH was tripled for ED versus controls. Even in young women, ED is a risk factor for PIH. An immunological explanation seems most likely, that is, the fetus is fully allogeneic to its mother. This risk must be acknowledged to inform couples and provide careful pregnancy monitoring. (C) 2016 by American Society for Reproductive Medicine

Mild COVID-19 infection does not alter the ovarian reserve in women treated with ART

International audienceResearch questionDoes mild COVID-19 infection affect the ovarian reserve of women undergoing an assisted reproductive technology (ART) protocol?DesignA prospective observational study was conducted between June and December 2020 at the ART unit of Tenon Hospital, Paris. Women managed at the unit for fertility issues by in-vitro fecundation, intracytoplasmic sperm injection (IVF/ICSI), fertility preservation, frozen embryo transfer or artificial insemination, and with an anti-Müllerian hormone (AMH) test carried out within 12 months preceding ART treatment, were included. All the women underwent a COVID rapid detection test (RDT) and AMH concentrations between those who tested positive (RDT positive) and those who tested negative (RDT negative).ResultsThe study population consisted of 118 women, 11.9% (14/118) of whom were COVID RDT positive. None of the tested women presented with a history of severe COVID-19 infection. The difference between the initial AMH concentration and AMH concentration tested during ART treatment was not significantly different between the COVID RDT positive group and COVID RDT negative group (–1.33 ng/ml [–0.35 to –1.61) versus –0.59 ng/ml [–0.15 to –1.11], P = 0.22).ConclusionA history of mild COVID-19 infection does not seem to alter the ovarian reserve as evaluated by AMH concentrations. Although these results are reassuring, further studies are necessary to assess the effect of COVID-19 on pregnancy outcomes in women undergoing ART

High-Dose Supplementation of Folic Acid in Infertile Men Improves IVF-ICSI Outcomes: A Randomized Controlled Trial (FOLFIV Trial)

International audienceDietary supplementation is commonly used in men with male infertility but its exact role is poorly understood. The aim of this multicenter, randomized, double-blind, placebo-controlled trial was to evaluate the impact of high-dose folic acid supplementation on IVF-ICSI outcomes. 162 couples with male infertility and an indication for IVF-ICSI were included for one IVF-ICSI cycle. Male partners of couples wishing to conceive, aged 18-60 years old, with at least one abnormal spermatic criterion were randomized in a 1:1 ratio to receive daily supplements containing 15 mg of folic acid or a placebo for 3 months from Day 0 until semen collection for IVF-ICSI. Sperm parameters and DNA fragmentation before and after the treatment and the biochemical and clinical pregnancy rates after the fresh embryo transfer were analyzed. We observed an increase in the biochemical pregnancy rate and a trend for a higher clinical pregnancy rate in the folic acid group compared to placebo (44.1% versus 22.4%, p = 0.01 and 35.6% versus 20.4%, p = 0.082, respectively). Even if no changes in sperm characteristics were observed, a decrease in DNA fragmentation in the folic acid group was noted (8.5 ± 4.5 vs. 6.4 ± 4.6, p < 0.0001). High-dose folic acid supplementation in men requiring IVF-ICSI for male infertility improves IVF-ICSI outcomes

The Goto-Kakizaki rat is a spontaneous prototypical rodent model of polycystic ovary syndrome

International audiencePolycystic ovary syndrome (PCOS) is characterized by an oligo-anovulation, hyperandrogenism and polycystic ovarian morphology combined with major metabolic disturbances. However, despite the high prevalence and the human and economic consequences of this syndrome, its etiology remains unknown. In this study, we show that female Goto-Kakizaki (GK) rats, a type 2 diabetes mellitus model, encapsulate naturally all the reproductive and metabolic hallmarks of lean women with PCOS at puberty and in adulthood. The analysis of their gestation and of their fetuses demonstrates that this PCOS-like phenotype is developmentally programmed. GK rats also develop features of ovarian hyperstimulation syndrome. Lastly, a comparison between GK rats and a cohort of women with PCOS reveals a similar reproductive signature. Thus, this spontaneous rodent model of PCOS represents an original tool for the identification of the mechanisms involved in its pathogenesis and for the development of novel strategies for its treatment

Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process.

peer reviewedInternational guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification-in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP

Tumeurs frontières de l'ovaire. Recommandations pour la pratique clinique du CNGOF – Texte court

International audienceThis work was carried out under the aegis of the CNGOF (Collège national des gynécologues et obstétriciens français) and proposes guidelines based on the evidence available in the literature. The objective was to define the diagnostic and surgical management strategy, the fertility preservation and surveillance strategy in Borderline Ovarian Tumor (BOT). No screening modality can be proposed in the general population. An expert pathological review is recommended in case of doubt concerning the borderline nature, the histological subtype, the invasive nature of the implant, for all micropapillary/cribriform serous BOT or in the presence of peritoneal implants, and for all mucinous or clear cell tumors (grade C). Macroscopic MRI analysis should be performed to differentiate the different subtypes of BOT: serous, seromucinous and mucinous (intestinal type) (grade C). If preoperative biomarkers are normal, follow up of biomarkers is not recommended (grade C). In cases of bilateral early serous BOT with a desire to preserve fertility and/or endocrine function, it is recommended to perform a bilateral cystectomy if possible (grade B). In case of early mucinous BOT, with a desire to preserve fertility and/or endocrine function, it is recommended to perform a unilateral adnexectomy (grade C). Secondary surgical staging is recommended in case of serous BOT with micropapillary appearance and uncomplete inspection of the abdominal cavity during initial surgery (grade C). For early-stage serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (grade C). Follow up after BOT must be pursued for more than 5 years (grade B). Conservative treatment involving at least the conservation of the uterus and a fragment of the ovary in a patient wishing to conceive may be proposed in advanced stages of BOT (grade C). A new surgical treatment that preserves fertility after a first non-invasive recurrence may be proposed in women of childbearing age (grade C). It is recommended to offer a specialized consultation for Reproductive Medicine when diagnosing BOT in a woman of childbearing age. Hormonal contraceptive use after serous or mucinous BOT is not contraindicated (grade C)